Cardiac evaluation in a patient with epileptic seizures: a value of cardiac magnetic resonance imaging.

Gulhane Military Medical Faculty, Department of Cardiology, 06018, Ankara, Turkey. Correspondence: Emre Yalcinkaya; GATA Etlik 06018 Ankara Turkey; E-mail: [email protected] Conflict of interest: There is no conflict of interest to declare. Received 11 July 2013; Accepted 22 July 2013. References To the Editor, We read with interest the article by Rocha et al.1 entitled “Takotsubo cardiomyopathy: a rare, but serious, complication of epileptic seizures”, which was published in the previous issue of Arquivos de Neuro-Psiquiatria. The authors1 presen­ ted a case of Takotsubo cardiomyopathy (TKC) in a patient with unexplained sinus tachycardia and troponin elevation after generalized epileptic seizures. The authors highlighted the importance of suspecting TKC in patients with seizures and signs of cardiac dysfunction. Although, the current case is interesting and well­presented one, some comments may be of beneficial. Takotsubo cardiomyopathy presents with a myocardial infarct­like clinical syndrome and is a cause of transient left ventricular systolic dysfunction, which tends to normalise approximately in a week2. It is often preceded by stress or exacerbation of an existing medical condition and results in angiographically normal coronary arteries2. Patients with electrocardiographic changes and eleva­ ted troponin biomarkers must be evaluated in detail to de­ tect an etiology and manage treatment. Stressful conditions such as epileptic seizures and entubation could trigger TKC. Evaluating cardiac wall motion abnormalities related to myo­ carditis, coronary vasospasm and coronary spontaneous dissection, which could be seen especially in peri­ and post­ menopausal women related to hormonal disturbances, could be difficult3. When etiology remains unclear, cardiac magne­ tic resonance (CMR) appears to be a useful imaging modality for documenting the extent of the regional wall motion ab­ normality and differentiating TKC from other cardiomyopa­ thies2. On CMR imaging, whereas TKC is characteristic in no or minimal late gadolinium enhancement (LGE), myocardial infarction is characteristic in subendocardial LGE, which extends variably transmurally to the epicardium2. Cardiovascular magnetic resonance imaging is a safe, useful, noninvasive modality that can be used in assessing myocardial function and tissue, differentiating and dia g­ nosing cardiomyopathies in suspected myocardial diseases even with angiographically normal coronary arteries2,4,5. Determining the precise etiology of electrocardiographic changes and elevated troponin biomarkers will help in esti­ mating true incidence of TKC in epileptic patients, thus increasing the strength of the studies and the prospective nature of TKC evaluation.